Case presentations:

• Male.
• 64 y.o.
• Presents to the hospital with persistent cough and hemoptysis.
• Heavy smoker and has lost about 4 kg weight during the last 3 months.

Teaching points:

• Lung cancer is the third most common cause of bone mets after breast and prostate cancer. Other primary solid malignancies with frequent extension to bone include: melanoma, renal Ca, thyroid Ca.
• The bone scan is not a specific procedure to detect malignant involvement, however type and distribution of lesions are often characteristic.
• Benign conditions mimicking bone mets include: fractures, benign tumors, Paget disease, and some metabolic disorders.
• The bone scan is a highly sensitive, inexpensive procedure for complete evaluation of the whole skeleton and it forms part of general oncologic work-up in malignancies known to have bone affinity or in patients with any malignant condition suffering from bone pain. -Hypertrophic osteoarthropathy(HOA) is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful, swollen joints.
• HOA is characterized by symmetric periostitisinvolving the radius, fibula, femur, humerus, metacarpals, and metatarsals. The syndrome can be primary (5%) or secondary (95%). (More teaching points in the case).